Panel V: The Analyst's Affect: The Way Back from Gridlock, Blindspots and Loss of Vitality

Panel Introduction
Maria L. Slowiaczek, Ph.D.

In our world of contemporary psychoanalysis, where we value the relationship as a vehicle for change, we enter into authentic, intimate relationships with our patients. But how do we manage our own feelings so that whatever we are feeling can be used in the service of the treatment, not inadvertently in the service of our own needs or self protection? In Self Psychology, we have focused on how the analyst's affective participation can create a feeling of connectedness and mutual empathy. Connection to the analyst's well-regulated affect provides stability and creates an emotional environment that allows the patient to develop ways to soothe and regulate their own overwhelming feelings. While it is recognized that the therapist can get drawn into emotional enactments, we expect these experiences to follow the course of a rupture that can lead to repair, bringing the participants onto more solid ground with each other. In this panel, we will present three clinical vignettes that focus on more long term, pervasive aspects of the analyst's affect that have affected the course of the treatment. In each vignette, the analyst's own vulnerabilities interact unconsciously with a particular patient contributing to gridlocks, blindspots or loss of vitality. We will describe the process of discovering these unconscious aspects of ourselves that were negatively affecting the treatment, as well as the ways that we used our own affect to find other aspects of the patient that we were previously unable to see.

Grief and Rejuvenation: A Mutual Journey
Maria L. Slowiaczek, Ph.D.

This paper describes a treatment with a woman in her 70s who was facing a phase of life after retirement that made her pause to reflect, to regret and to hope that life could still offer some of the things that she missed out on. As an analyst who is only a bit younger than this patient, who I call Marta, I felt many similarities between us, and the story of the treatment is one of coming to recognize some things in myself, so that I could be better able to help her. In our initial meetings, I led her to believe that we would grow into a very intimate relationship and that our relationship would be a significant part of what would lead to change. However, I spent an entire year with Marta allowing us to stay a safe distance from each other that prevented us from really connecting. This year of living together in a relatively superficial space ended when one day Marta asked me what had happened to the relationship between us that I had said would be so important to the treatment.

Marta's question forced me to look at myself - at my own aging and sorrows and I realized that I had been unwilling to face some of my own grief and therefore could not really help her with hers. I sought help for my unprocessed painful feelings and only then was able to reengage with Marta in a more intimate way. This new connection between us allowed me to use my early childhood feelings of neglect and sorrow to help Marta to reconnect with her early childhood feelings. She had felt held in a state of paralysis and guilt for many years about her brother's suicide and her inability to save him, and only as she was able to see how these feelings were tied to her sense of responsibility in childhood for her mentally ill mother was she able to release herself from the guilt and experience the grief. This became possible because Marta and I were both able to go back to find the parts of ourselves that were left behind, and then to face our grief together.

One's Blind But Now We See
Heather Ferguson, LCSW

In this case presentation, I describe my long-term treatment with Heidi, a successful business woman with a traumatic history. Six years into our once captivating work, foggy deadness envelops us, rendering us confused about the loss of our passionate engagement. Our mutual aliveness, our place of contact, is now obscured by a foggy disconnect.

In order to loosen our deadlock, I wonder how I am contributing to our stalemate, the collapse of reflective space. I recognize my discomfort with deadness, a familiar countertransference sinkhole, immobility my Achilles heel. A potent dream arrives, first for Heidi and then for me, which revitalizes our dialogue. As part of our reparative process, I share my dream with Heidi and we explore its complex, intersubjective meanings, reestablishing mutuality and empathic understanding. Our shared reciprocal dream life becomes the site of renewed connection, mutual vulnerability, and vital witnessing.

Lily's Lament
Doris Brothers, Ph.D.

It was only after her analyst, Dr. A., held a clock to her ear when the phone rang during a session, an unmistakable sign of her growing dementia, that Lily reluctantly ended a 5-day-a-week analysis that had lasted 25 years. Lily spent the first years of her analysis with me trying to understand her relationship with Dr. A. When we discovered that Dr. A. had failed to recognize the importance of a familial trauma, Lily developed a powerfully idealizing relationship with me. The vehemence and despair with which she reacted to the smallest failure in my empathic responsiveness surprised me. Realizing that acknowledging my failures in empathic attunement and inquiring into her reactions only enraged and wounded her more, I decided that I would simply try to survive her attacks without delving into their meaning. When at last I connected the grief I had experienced over the premature ending of my own analysis with Lily's loss of Dr. A, her intense reactions to my failures in attuned responsiveness suddenly made sense. They signaled to Lily that I too could be losing my mind. We were then able to work through the ways in which I was threatening Lily with the repetition of a traumatic loss. Finally, Lily became able to grieve the death of Dr. A.

About the same time that Dr. A's cognitive decline had forced Lily to end her analysis, my very elderly mother was beginning to show signs of dementia, a condition that worsened over the course of my relationship with Lily. I doubt that I could have let myself know that Lily was experiencing my failures in empathic responsiveness as signs that I too could be losing my mind without feeling overcome with my own grief. By the time that I connected with my sorrow, I, much like Lily, was close to losing the woman who had, in very complicated ways, most profoundly affected my life. Lily and I had both lost our mothers.

Theoretical Framing and Commentary on Three Clinical Vignettes
Illustrating the Centrality of the Analyst's Affect in the Curative Process
Judy Teicholz, Ed.D.

Our new recognition of the inescapable intersubjectivity of the analytic relationship requires that we include as much about the analyst's affect as the patient's in our clinical material. But the very centrality of the analyst's affect in the treatment relationship means that it can be a force either for good or for ill. We are thus confronted with a clinical paradox: Kohut told us to attend to our own affect as analysts and to monitor our countertransference. At the same time he urged us to hold the patient's subjectivity supreme. This is a specifically intersubjective challenge suggesting that it's only through the processing and expression of our own affect as analysts that we're able to engage therapeutically with our patients.

The focus is on the mutual influence between patient and analyst at profound affective levels. The affect, whether spoken or unspoken infuses our words and can counter their intended meaning. We're thus vulnerable as analysts to having unconscious elements of our affective experience enter the therapeutic relationship in ways that disrupt our analytic functioning. Such vulnerability requires an unwavering commitment on our parts to look to ourselves whenever an impasse emerges in any treatment relationship. All three clinical presenters on this Panel exemplified this process of analytic self-examination, each one providing a beautifully complex narrative that described how she discovered and resolved her own affective roadblocks in a particular treatment, enabling her to reconnect and move forward with her patient again.

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